Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion

Collin, Philippe; Matsumura, Noboru; Lädermann, Alexandre; Denard, Patrick J.; Walch, Gilles

doi:10.1016/j.jse.2013.11.019

Cited by 266 publications

(193 citation statements)

References 27 publications

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“…For example, although there are no established rules about the magnitude of the tear and the treatment options, the presence and the size of the rotator cuff tears could limit the therapeutic capacity of the exercises that underline the necessity of a correct diagnostic [9,88] . Massive chronic rotator cuff tears are often associated to restricted or loss of active shoulder range of motion [89] . Further, size of the tears could be related to joint inflammation and tissue remodeling, both of which are important for the advancement of rotator cuff treatment [90] , but more research is necessary.…”

Section: Conservative Treatment Of Shoulder Tendinopathymentioning

confidence: 99%

Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives

Camargo

Alburquerque‐Sendín

Salvini

2014

WJO

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Excessive mechanical loading is considered the major cause of rotator cuff tendinopathy. Although tendon problems are very common, they are not always easy to treat. Eccentric training has been proposed as an effective conservative treatment for the Achilles and patellar tendinopathies, but less evidence exists about its effectiveness for the rotator cuff tendinopathy. The mechanotransduction process associated with an adequate dose of mechanical load might explain the beneficial results of applying the eccentric training to the tendons. An adequate load increases healing and an inadequate (over or underuse) load can deteriorate the tendon structure. Different eccentric training protocols have been used in the few studies conducted for people with rotator cuff tendinopathy. Further, the effects of the eccentric training for rotator cuff tendinopathy were only evaluated on pain, function and strength. Future studies should assess the effects of the eccentric training also on shoulder kinematics and muscle activity. Individualization of the exercise prescription, comprehension and motivation of the patients, and the establishment of specific goals, practice and efforts should all be considered when prescribing the eccentric training.In conclusion, eccentric training should be used aiming improvement of the tendon degeneration, but more evidence is necessary to establish the adequate doseresponse and to determine long-term follow-up effects. Key words: Cellular; Mechanotransduction; Rehabilitation; Shoulder Impingement; Supraspinatus; Tendon injuries Core tip: Eccentric training can be considered a new and ambitious treatment approach for several tendinopathies. The paper establishes the basic principles for explaining the effects on the tendon of an intense mechanical load, as the eccentric training. Further, the authors bring other possible explanations of the success of this training for tendinopathies, as the individualization of the exercise programs and the motivation of the patients who reach specific goals. Negative and side effects are also identified. Finally, the main evidence afforded by original articles is commented and future research purposes are defined.Camargo PR, Alburquerque-Sendín F, Salvini TF. Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives. World J Orthop 2014; 5(5): 634-644 Available from:

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Section: Conservative Treatment Of Shoulder Tendinopathymentioning

confidence: 99%

Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives

Camargo

Alburquerque‐Sendín

Salvini

2014

WJO

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“…Boileau et al [2] described three clinical presentations in poorly compensated massive rotator cuff tears: isolated loss of external rotation, isolated pseudoparalysis, and combined loss of active elevation and external rotation. They suggested the latter situation was caused by combined teres minor, infraspinatus and supraspinatus failure [2]-an anatomy equivalent to the classification by Collin et al [4] of massive rotator cuff tear Type E, representing a vertical and horizontal muscular imbalance. However, in the current study, only 33% of patients with Type E tears showed a combined loss of active elevation and external rotation pattern.…”

Section: Discussionmentioning

confidence: 89%

“…The methods were described in an earlier study [4] and consisted of standard baseline characteristics and recording of ROM in all patients. Pseudoparalysis was defined as less than 90°active anterior elevation with maintained passive elevation [26].…”

Section: Study Variables and Clinical Evaluationmentioning

confidence: 99%

“…Based on CT arthrogram findings, the rotator cuff tears were divided in five components and then classified in five types (Fig. 5) [4].…”

Section: Radiographic Evaluation and Study Definitionsmentioning

confidence: 99%

“…However, evidence suggests that its integrity may be one of the most important variables affecting the outcome of reverse shoulder arthroplasty for massive rotator cuff tears [10,22]. The functional effects on day-to-day activities can be important [4,18,20], and previous research [5] has shown that teres minor integrity affects the outcomes of tendon transfers in massive rotator cuff tears.…”

Section: Introductionmentioning

confidence: 99%

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What is the Best Clinical Test for Assessment of the Teres Minor in Massive Rotator Cuff Tears?

Treseder

Denard

Neyton

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Few studies define the clinical signs to evaluate the integrity of teres minor in patients with massive rotator cuff tears. CT and MRI, with or without an arthrogram, can be limited by image quality, soft tissue density, motion artifact, and interobserver reliability. Additionally, the ill-defined junction between the infraspinatus and teres minor and the larger muscle-totendon ratio of the teres minor can contribute to error. Therefore, we wished to determine the validity of clinical testing for teres minor tears.Question/Purposes The aim of this study was to determine the accuracy of commonly used clinical signs (external rotation lag sign, drop sign, and the Patte test) for diagnosing the teres minor's integrity. Methods We performed a prospective evaluation of patients referred to our shoulder clinic for massive rotator cuff tears determined by CT arthrograms. The posterosuperior rotator cuff was examined clinically and correlated with CT arthrograms. We assessed interobserver reliability for CT assessment and used three different clinical tests of teres minor function (the external rotation lag sign, dropOne of the authors certifies that he (PC), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount less than USD 10,000 from Storz (Guyancourt, France), and an amount of USD 10,000-USD 100,000 from Tornier (Montbonnot, France). One of the authors certifies that he (GW), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000 from Tornier (Montbonnot, France). One of the authors certifies that he (PJD), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Arthrex (Naples, FL, USA). One of the authors certifies that he (LN), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USA 10,000 to USD 100,000 from Tornier (Montbonnet, France). 123Clin Orthop Relat Res (2015) 473:2959-2966 DOI 10.1007 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® sign, and the Patte test). One hundred patients with a mean age of 68 years were available for the analysis. Results The most accurate test for teres minor dysfunction was an external rotation lag sign greater than 40°, which had a sensitivity of 100% (95% CI, 80%-100%) and a specificity of 92% (95% CI, 84%-96%). External rotation lag signs greater than 10°had a sensitivity of 100% (95% CI, 80%-100%) and a specificity of 51% (95% CI, 40%-61%). The Patte sign had a sensitivity of 93% (95% CI, 70%-99%) and a specificity of 72% (95% CI, 61%-80%). The drop sign had a sensitivity of 87% (95% CI, 62%-96%) and a specificity of 88% (95% CI, 80%-

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Rotator Cuff Fibro‐Adipogenic Progenitors Demonstrate Highest Concentration, Proliferative Capacity, and Adipogenic Potential Across Muscle Groups

Lee

Agha

Liu

et al. 2019

Journal Orthopaedic Research

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Fatty infiltration (FI) of rotator cuff (RC) muscles is common in patients with RC tears. Studies have demonstrated that fibro-adipogenic progenitors (FAPs), a population of resident muscle stem cells, are the main contributors of FI, which adversely affects muscle quality and RC repair success. Although FI is common in RC injuries, it is not frequently reported after other musculotendinous injuries. Additionally, studies have shown the development of different pathology patterns across muscle groups suggestive of intrinsic differences in cellular composition and behavior. This study evaluates FAP distribution and differentiation properties across anatomic locations in mice. Muscles from seven different anatomic locations were harvested from PDGFRα-eGFP FAP reporter mice. FAPs were quantified using histology and FACS sorting with BD Aria II with CD31 − /CD45 − /Integrinα7 − /Sca-1 + and PDGFRα reporter signal (n = 3 per muscle). The cells were analyzed for adipogenesis using immunocytochemistry and for proliferation properties with Brdu-Ki67 staining. In a separate group of mice, RC and tibialis anterior muscles received glycerol injection and were harvested after 2 weeks for FI quantification (n = 4). One-way analysis of variance was used for statistical comparisons among groups, with significance at p < 0.05. FAPs from the RC, masseter, and paraspinal muscles were more numerous and demonstrated greater proliferative capacity and adipogenic potency than those from the tibialis anterior and gastrocnemius. The RC demonstrated significantly greater levels of FI than the tibialis anterior after glycerol-injection injury. Clinical Significance: This study suggests differences in FAP distribution and differentiation characteristics may account for the propensity to develop FI in RC tears as compared with other musculotendinous injuries.

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Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion

Cited by 266 publications

References 27 publications

Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives

Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives

What is the Best Clinical Test for Assessment of the Teres Minor in Massive Rotator Cuff Tears?

Rotator Cuff Fibro‐Adipogenic Progenitors Demonstrate Highest Concentration, Proliferative Capacity, and Adipogenic Potential Across Muscle Groups

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